Background Very few publications have evaluated discontinuation rates with biologics in juvenile idiopathic arthritis (JIA) and the factors associated with treatment withdrawal.
Objectives To analyze the clinical progress of patients with JIA who discontinue anti-tumor necrosis factor-α after achieving clinical remission
Methods Retrospective study of the clinical records of patients in a tertiary-level hospital diagnosed with juvenile idiopathic arthritis, who received anti-tumor necrosis factor-α between January 2007 and December 2012. Characteristics and progress of a subgroup of patients who discontinued anti-tumor necrosis factor-α because they had met criteria for clinical remission on medication were specifically analyzed. Statistical analysis was performed using the SPSS package version 21.
Results Of the 40 patients included in the study, treatment was discontinued in 22 (3 were receiving adalimumab and 19 etanercept) who met criteria for clinical remission on medication. Treatment was withdrawn by tapering the dose and/or increasing the dosing interval. No significant differences were found between the patient groups with and without anti-TNFα discontinuation, and the groups with and without relapse, with regard to sex, age, ANA and RF positivity, time between diagnosis and starting anti-TNFα, time to achieve clinical remission, and time of anti-TNFα treatment alone and in combination with MTX. Seven patients (32%) still had inactive disease at the end of the study. 3 had persistent oligoarthritis, 1 polyarthritis, 1 systemic JIA and 2 enthesitis-related arthritis. Five of these met criteria for clinical remission off medication, with a mean treatment-free time of 15.4 months.Medication had to be reintroduced due to relapse in 2 patients (66%) who had discontinued adalimumab, a mean of 4 (SD 0) months after discontinuation, and in 13 patients (68%) who discontinued etanercept, a mean of 2.9 (SD 1.8) months after discontinuation.Most patients responded well to reintroduction of the initial anti-TNFα therapy after relapse
Conclusions Most patients relapse after treatment is discontinued for remission. These results are similar to others published to date. We need larger studies to clarify clinical features and biomarkers that may allow us to select patients whom anti-TNF could be withdrawn due to inactive disease.
Iglesias E, Torrente-Segarra V, Bou R, Ricart S, González MI, Sánchez J, Calzada J, Antόn J. Non-systemic juvenile idiopathic arthritis outcome after reaching clinical remission with anti-TNF-α therapy: a clinical practice observational study of patients who discontinued treatment. Rheumatol Int. 2014 Aug;34(8):1053-7
Yubo Cai, Xiaosheng Liu, Wenming Zhang, Jianrong Xu, Lanfang Cao (2013). Clinical trial of etanercept tapering in juvenile idiopathic arthritis during remission. Rheumatology International. 33:2277–2282.
Disclosure of Interest None declared